Everyone feels sad or blue sometimes.
It is a natural part of life. But when the sadness persists and
interferes with everyday life, it may be depression. Depression is not
a normal part of growing older. It is a treatable medical illness,
much like heart disease or diabetes.
Depression is a serious illness
affecting approximately 15 out of every 100 adults over age 65 in the
United States. The disorder affects a much higher percentage of people
in hospitals and nursing homes. When depression occurs in late life,
it sometimes can be a relapse of an earlier depression. But when it
occurs for the first time in older adults, it usually is brought on by
another medical illness. When someone is already ill, depression can
be both more difficult to recognize and more difficult to endure.
Depression Is Not A Passing Mood
Sadness associated with normal grief or everyday "blues" is
different from depression. A sad or grieving person can continue to
carry on with regular activities. The depressed person suffers from
symptoms that interfere with his or her ability to function normally
for a prolonged period of time.
Recognizing depression in the elderly
is not always easy. It often is difficult for the depressed elder to
describe how he or she is feeling. In addition, the current population
of older Americans came of age at a time when depression was not
understood to be a biological disorder and medical illness.
Therefore, some elderly fear being
labeled "crazy," or worry that their illness will be seen as a
character weakness.
The depressed person or their family
members may think that a change in mood is simply "a passing mood,"
and the person should just "snap out of it." But someone suffering
from depression can not just "get over it." Depression is a medical
illness that must be diagnosed and treated by trained professionals.
Untreated, depression may last months
or even years.
Untreated depression can:
- lead to disability
- worsen symptoms of other illnesses
- lead to premature death
- result in suicide
When it is properly diagnosed and
treated, more than 80 percent of those suffering from depression
recover and return to their normal lives.
The most common symptoms of late-life
depression include:
- persistent sadness (lasting two
weeks or more)
- feeling slowed down
- excessive worries about finances and
health problems
- frequent tearfulness
- feeling worthless or helpless
- weight changes
- pacing and fidgeting
- difficulty sleeping
- difficulty concentrating
- physical symptoms such as pain or
gastrointestinal problems
One important sign of depression is
when older people withdraw from their regular social activities.
Rather than explaining their symptoms as a medical illness, often
depressed persons will give different explanations such as:
"It's too much trouble,"
"I don't feel well enough," or
"I don't have the energy."
For the same reasons, they often
neglect their personal appearance, or may begin cooking and eating
less.
Like many illnesses, there are varying
levels and types of depression. A person may not feel "sad" about
anything, but may exhibit symptoms such as difficulty sleeping, weight
loss, or physical pain with no apparent explanation. This person still
may be clinically depressed. Those same symptoms also may be a sign of
another problem, only a doctor can make the correct diagnosis.
It Can Happen To Anyone
Sometimes depression will occur for no apparent reason. In other
words, nothing necessarily needs to "happen" in one's life for
depression to occur. This can be because the disease often is caused
by biological changes in the brain. However, in older adults, there
usually are understandable reasons for depression. As the brain and
body age, a number of natural bio-chemical changes begin to take
place. Changes are the result of aging, medical illnesses or genetics
may put the older adult at a greater risk for developing depression.
Life Changes
Chronic or serious illness is the most common cause of depression
in the elderly. But even when someone is struggling with a chronic
illness such as arthritis, it is not natural to be depressed.
Depression is defined as an illness if it lasts two weeks or more and
if it affects one's ability to lead a normal life.
Many factors can contribute to the
development of depression. Often people describe one specific event
that triggered their depression, such as the death of a partner or
loved one, or the loss of a job through layoff or retirement. What
seems like a normal period of sadness or grief may lead to prolonged,
intense grief that requires medical attention.
The loss of a life-long partner or a
friend is a frequent occurrence in later life. It is normal to grieve
after such a loss. But it may be depression rather than bereavement if
the grief persists, or is accompanied by any of the following
symptoms:
- guilt unconnected with the loved
one's death
- thoughts of one's own death
- persistent feelings of worthlessness
- inability to function at one's usual
level
- difficulty sleeping
- weight loss
If any of these symptoms are triggered
by a loss, a physician should be consulted.
Changes on the older adult's sensory
abilities or environment may contribute to the development of
depression. Examples of such changes include:
- changes in vision and hearing
- changes in mobility
- retirement
- moving from the family home
- neighborhood changes
Other Illness
In the older population, medical illnesses are a common trigger
for depression, and often depression will worsen the symptoms of other
illnesses. The following illnesses are common causes of late-life
depression:
- cancer
- Parkinson's disease
- heart disease
- stroke
- Alzheimer's disease
In addition, certain medical illnesses
may hide the symptoms of depression. When a depressed person is
preoccupied with physical symptoms resulting from a stroke,
gastrointestinal problems, heart disease or arthritis, he or she may
attribute the depressive symptoms to an existing physical illness, or
may ignore the symptoms entirely. For this reason he or she may not
report the depressive symptoms to his or her doctor, creating a
barrier to becoming well.
Depression Is Treatable
Most depressed elderly people can improve dramatically with treatment.
In fact, there are highly effective treatments for depression in late
life. Common treatments prescribed by physicians include
psychotherapy, antidepressant medications, and electroconvulsive
therapy (ECT).
Psychotherapy can play an important
role in the treatment of depression with, or without, medication. This
type of treatment is most often used alone in mild to moderate
depression.
There are many forms of short-term
therapy (10-20 weeks) that have proven to be affective. It is
important that the depressed person find a therapist with whom he or
she feels comfortable and who has experience wit older patients.
Antidepressants work by increasing the
level of neurotransmitters in the brain. Neurotransmitters are the
brain's "messenger." Many feelings, including pain and pleasure, are a
result of neurotransmitters' function. When the supply of
neurotransmitters is imbalanced, depression may result.
A frequent reason some people do not
respond to antidepressant treatment is because they do not take the
medication properly. Missing doses or taking more than the prescribed
amount of the medication compromises the effect of the antidepressant.
Similarly, stopping the medication too soon often results in a relapse
of depression. In fact, most patients who stop taking their medication
before four to six months after recovery will experience a relapse of
depression.
Electroconvulsive therapy (ECT) is a
treatment which is sometimes prescribed in cases of severe depression,
if a peson is unable to take or does not respond to medication, or if
a person is suicidal. The side effects and procedures associated with
ECT should be carefully and thoroughly discussed and examined.
The treatment of depression demands
patience and perseverance for the patient and the physician. Sometimes
several different treatments must be tried before full recovery. Each
person has individual biological and psychological characteristics
that require individualized care.
Paying For Treatment
If the person seeking treatment participates in a private insurance or
a health maintenance organization (HMO) plan, the costs of treatment
may be covered. The health insurance provider should be contacted for
details on the coverage for treatment of clinical depression.
If not covered by insurance and
treatment is not affordable, the community may have publicly-funded
mental health centers and other mental health programs that calculate
the cost of many services according to what is affordable. This is
called sliding-scale or sliding-fee basis of payment. So, regardless
of financial status, there are services available. Some mental health
professional in private practice may also accept patients on a
sliding-fee basis.
Suicide
Suicide is more common in older people than in any other age
group. The population over age 65 accounts for more than 25 percent of
the nations suicides. In fact, white men over age 80 are six times
more likely to commit suicide than the general population,
constituting the largest risk group. Suicide attempts or severe
thoughts or wishes by older adults must always be taken seriously.
It is appropriate and important to ask
a depressed person:
- Do they feel as though life is no
longer an option for them?
- Have they had thoughts or made
comments about harming themselves?
- Are they planning to do it?
- Is there a collection of pills or
guns in the house?
- Are they often alone?
Most depressed people welcome care,
concern and support, but they are frightened and may resist help. In
the case of a potentially suicidal elder, caring friends or family
members must be more than understanding. They must actively intervene
by removing pills and weapons from the home and calling the family
physician, mental health professional or, if necessary, the police.
Caring For a Depressed Person
The first step in helping an elderly person who may be depressed
is to make sure he or she gets a complete physical checkup. Depression
may be a side effect of a pre-existing medical condition or of a
medication. If the depressed older adult is confused or withdrawn, it
is helpful for a caring family member or friend to accompany the
person to the doctor and provide important information.
The physician may refer the older adult
to a psychiatrist with geriatric training or experience. If a person
is reluctant to see a psychiatrist, he or she may need assurance that
an evaluation is necessary to determine if treatment is needed to
reduce symptoms, improve functioning and enhance well-being.
Source: National Mental Health
Association
